Complex Regional Pain Syndrome | DrBurke

Definition

Complex Regional Pain Syndrome (CRPS) is a type of arthritis that ranges between sub-acute and chronic arthritis in terms of disease duration. It is also known as Sympathetic Dystrophy Syndrome (SDS).  It is the disease of the autonomic nervous system. The autonomic nervous system is the peripheral nervous system which exerts involuntary control of many bodily functions e.g. breathing, digestion etc.

The term sympathetic dystrophy refers to wasting of nerve tissue secondary to poor innervation. This results in sympathetic nerve tissue damage. The damage can either be reversible or irreversible depending on the disease stage.

Causes of CRPS

The etiological factors of CRPS divide the disease into two main categories:

  • CRPS Type 1 which is typically caused by:
    • A crush injury
    • Soft Tissue Injury (STI)
    • Tightly tied therapeutic casts
  • CRPS Type 2 is often caused by direct nerve injury secondary to:
    • Trauma
    • Surgery

Symptoms of CRPS

The clinical manifestations of CRPS are classified according to stages. These stages describe and determine the degree of nerve tissue damage. That is, whether restoration of innervation can reverse the dystrophy or not.

CRPS joint pain involvement is indiscriminate. It ranges from small joints to large joints. It doesn’t follow any particular pattern, as joint symmetry tends to be inconsistent.

There are 3 main clinical stages of CRPS:

  • Stage 1:
    • Dull joint pain is described. Commonly the hip joint, joints of the spine and the knee joint. However, depending on the site of injury, any joint can be involved in CRPS.
    • Swelling around the joint region
    • Joint stiffness
    • Slight limitation of joint mobility
    • Changes in local skin temperature on the affected joint compared to the non-affected joint
  • Stage 2
    • Joint pain escalates to intense burning pain.
    • Swelling around the joint may become noticeable.
    • Significantly compromised joint mobility
    • Associated neighboring muscle spasm
    • Local temperature becomes markedly cold compared to the unaffected joint region
    • Localized skin color changes
  • Stage 3 – Irreversible nerve tissue dystrophy
    • Throbbing, intense aching joint pain
    • Severely reduced joint movement
    • Muscular wasting
    • Associated limb wasting

Treatment of CRPS

Based on the clinical staging of CRPS, treatment is adjusted to abate symptoms and prevent further nerve tissue damage. Restoration of nourishment in the starved nerve is key to minimizing morbidity in CRPS which is achieved by removing the inflicting factors. Our Orthopedic surgeon, Dr. Burke, uses a combination of two or more therapeutic approaches to ensure optimum treatment is delivered to all his patients. These treatment plans include:

  • Prescribed medication
    • Calcium channel blockers
    • Local injectable anaesthetic drugs
    • Alpha channel blockers
    • Stellate ganglion blocks
  • Physical therapy
  • TENS (Transcutaneous Electrical Nerve Stimulatory)
  • Biofeedback therapy